Identifying surgical patients at risk for discharge to a post-acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient-reported frailty screen and non-home discharge (NHD).
Prospective cohort.
Urban tertiary academic preoperative evaluation center.
Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3?days or longer.
Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient-reported items and NHD.
A total of 230 patieD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.
Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.Community psychology is expressly concerned with social justice. Such concern necessitates attention to race. Yet, nearly absent from the field's literature is explicit and critical attention to whiteness. Thus, community psychology's contribution to promoting social justice remains incomplete. In this article, we examine how a critical construction of whiteness can be useful for community research and action. After a brief history of the construction of whiteness in the United States, and a summary of key insights from critical whiteness studies, we present a scoping review of the nascent body of community psychology literature that addresses whiteness. That work implicates whiteness in the emergence of the field itself, frames whiteness as social location, problematizes whiteness, addresses White supremacy and institutional racism, interrogates White privilege, and employs whiteness as a theoretical standpoint. We conclude with three propositions for scholars to broker the relationship between community psychology and critical whiteness studies (a) community psychology should become more critically conscious of whiteness, (b) community psychologists should promote critical awareness of the ways that whiteness operates as a complex system, and (c) greater critical awareness of whiteness should be applied to the development of multilevel interventions aimed at dismantling whiteness as a system of domination.Steroid-resistant nephrotic syndrome (SRNS) is a clinical challenge with variable clinical outcomes. In patients with SRNS, unsuccessful anti-inflammatory and anti-proteinuric effects of steroids lead to end-stage renal disease (ESRD). Our objective was to define the expression pattern of the glucocorticoid receptors (GR) α and β and their epigenetic regulators (miR-24, miR-30a, and miR-370) in a group of adults with SRNS. In this regard, sixty primary NS patients with focal segmental glomerulosclerosis (FSGS, N?=?30) and membranous glomerulonephritis (MGN, N?=?30) and also healthy volunteers (N?=?24) were enrolled. Real-time PCR was performed to evaluate the expression levels of the aforementioned genes in peripheral blood mononuclear cell (PBMC) samples. https://www.selleckchem.com/products/blu-667.html Furthermore, an in-silico analysis was performed to understand the signaling pathways and biological procedures that may be targeted by these microRNAs in NS. The decreased and increased levels of GRα and GRβ were not significant, respectively. Statistically significant reduced miR-24 levels were observed between control/MGN (p?=?.022) and MGN/FSGS (p?=?.032) groups. Additionally, a decrease was detected in miR-30a between MGN and FSGS (p?=?.049) groups. There was a significant increase in miR-370 expression level between control and NS groups (p?=?.029), as well as control/MGN (p?=?.008), and MGN/FSGS (p?=?.046). Bioinformatics analysis predicted the possible targets of the studied genes including genes involved in TGF-β, Notch1, and p53 signaling pathways, regulation of gene expression, intracellular signal transduction, negative regulation of response to the stimulus, cell-cell signaling, and cell activation in the pathogenesis of SRNS. Taken all together, dysregulated levels of GRα, GRβ were not attributed to SRNS in our patients. It seems that pharmacokinetics and the genetic variations in podocyte-related genes may be associated with the steroid-resistance in our adult patients with NS rather than GR expression.Effort during listening is commonly measured using the task-evoked pupil response (TEPR); a pupillometric marker of physiological arousal. However, studies to date report no association between TEPR and perceived effort. One possible reason for this is the way in which self-report effort measures are typically administered, namely as a single data point collected at the end of a testing session. Another possible reason is that TEPR might relate more closely to the experience of tiredness from listening than to effort per se. To examine these possibilities, we conducted two preregistered experiments that recorded subjective ratings of effort and tiredness from listening at multiple time points and examined their covariance with TEPR over the course of listening tasks varying in levels of acoustic and attentional demand. In both experiments, we showed a within-subject association between TEPR and tiredness from listening, but no association between TEPR and effort. The data also suggest that the effect of task difficulty on the experience of tiredness from listening may go undetected using the traditional approach of collecting a single data point at the end of a listening block. Finally, this study demonstrates the utility of a novel correlation analysis technique ("rmcorr"), which can be used to overcome statistical power constraints commonly found in the literature. Teasing apart the subjective and physiological mechanisms that underpin effortful listening is a crucial step toward addressing these difficulties in older and/or hearing-impaired individuals.